Jeffrey Brosco, M.D., Ph.D., has received a prestigious Director’s Award from the federal Maternal and Child Health Bureau (MCHB). The award recognizes his far-reaching state and national contributions to the health of infants, mothers, children, adolescents, and children with special needs.
Dr. Brosco is professor of clinical pediatrics and associate director of the Mailman Center for Child Development at the University of Miami Miller School of Medicine. He also is director of the Florida Department of Health Title V Children and Youth with Special Health Care Needs program.
The award from MCHB, part of the Department of Health and Human Services, underscores Dr. Brosco’s groundbreaking work over 30 years to improve the health and wellness of children in Florida and beyond.
Dr. Brosco helps oversee distribution of MCHB Title V federal grant money awarded to Florida each year. Historically, states have focused on narrow projects providing direct services that affect only a small portion of the pediatric population. Dr. Brosco wants to change that trend. He asks, “How do we reach all of the children in our state, particularly those who have special health care needs, including physical, behavioral and educational needs? We’re trying to reach a broader population.”
One example of that is to work with health insurers to measure quality of life for both the child and the family.
In addition to historical quality measures such as whether a child is receiving proper immunizations and getting regular checkups, one insurer is now measuring whether the child is going to school and participating in community events, and whether a family is experiencing overwhelming stress due to a child’s illness or other circumstances. This insurer is tracking quality of life information on about 71,000 children. Dr. Brosco is encouraging other insurers to follow.
“What we measure is what we reward,” he said. “We’re trying to change the system to focus on health and well-being rather than illness. If we measure and reward quality of life, that will change our behavior as a health care system.”
Pediatric behavioral health is a top priority for Dr. Brosco. “More than 400,000 children in Florida have a behavioral health diagnosis such as depression, anxiety, attention deficit hyperactivity disorder or other behavioral disorder,” he said. “Of those, fewer than 200,000 get any treatment. If we had even 2,000 children with cancer not getting treatment, it would be a national scandal.”
Dr. Brosco says insufficient access to behavioral health services is a dilemma for every state. To address the lack of access and shortage of mental health professionals, the Florida Department of Health, under the direction of Dr. Brosco, has established pilot programs in half a dozen Florida cities.
“We’re working with primary care physicians and nurses to treat most children with ADHD, anxiety and depression, and we’re supporting them in their offices with mental health professionals using telehealth or other connections,” Dr. Brosco said.
“When we’re looking at issues like suicide rates, drug crises and school shootings, we can’t continue to fail to address mental health issues in our youth.”
Training Leaders to Change Future Care for Neurodevelopmental Disabilities
Dr. Brosco is also director of the graduate training program Leadership Education in Neurodevelopmental Disabilities (LEND) at the Mailman Center for Child Development.
The program recruits graduate students in a variety of health fields from all over the country and trains them how to change systems. Of 50 training programs in the country, it’s one of the largest and has trained about 25 percent of Hispanic LEND graduates nationwide.
Students incorporate LEND training into their academic discipline. LEND emphasizes interprofessional training, family-professional partnerships, and cultural humility.
“Cultural humility, a term similar to cultural competence, is a training approach that starts with the idea that you don’t know anything about a person's values until you’ve talked to them and learned what values matter to them,” Dr. Brosco said. “It’s about recognizing that my values may be different from another person’s.”
LEND has been training 90 graduate students a year for the past two decades. Dr. Brosco’s team has tracked graduates’ progress five years after training. He reports, “At least 85 percent are practicing in interprofessional teams and 75 percent have positions of leadership. We feel like it has a big impact. They’re using their principles in their work.
“Clinicians are good at helping one person at a time. But how do you help all children with ADHD or autism in our state -- whole populations of children? Making the leap to leadership advocacy systems is the challenging part of the training.”
A National Presence
Dr. Brosco has published more than 100 articles in scholarly journals and periodicals, received millions of dollars in research grants, and presented countless lectures and presentations on a variety of topics. Dr. Brosco chaired the national Newborn Screening Translational Research Network and serves on the Advisory Committee on Heritable Disorders in Newborns and Children, as well as the National Workgroup on Standards for Systems of Care for Children and Youth with Special Health Care Needs.
He speaks passionately about his work: “I love the work I do. Some days I see an individual child and his family and help that particular child. When I feel frustrated about how the system is limiting what I can do for that child, I get to work on systems change. And I’m working with bright young people, great people in the state and at the University of Miami.
“Every single person I work with really wants children and families to do better. At the individual level, we can definitely see differences. We’re still working on things at the population level, and I’m hoping to see the measures of child health and well-being for our state improve in the coming years.”